Table 2.
Commonly used medications in children receiving GA. Drug doses from BNFC.12,16 Paracetamol and ibuprofen dosing as per BNFc or local protocols. ∗Propofol and remifentanil TCI have limited evidence in asthma. They can be used to maintain anaesthesia or sedation on ITU. BC, bronchoconstriction; BD, bronchodilatation.
| Name | Dose | Clinical Utility in Asthma | Side effects/cautions |
|---|---|---|---|
| Induction agents | |||
| Ketamine | 1–2 mg kg−1 | Maintains airway tone Promotes bronchodilation (BD) through catecholamine release |
Caution in volume depleted states as may have a negative ionotropic effect |
| Propofol∗ | 2.5–4 mg kg−1 | May promote BD | Hypotension |
| Sevoflurane | 0–8% | Promotes BD Maintains spontaneous ventilation |
Requires an anaesthetic delivery circuit |
| Thiopental | Not recommended | May cause BC | |
| Methohexital | Not recommended | Alters airway tone and cause upper airway obstruction | |
| Etomidate | Not recommended | Increased airway resistance | |
| Maintenance of anaesthesia | |||
| Ketamine | 10–45 μg kg−1 min−1 | As above | |
| Volatile agents | Sevoflurane | Promotes BD | Desflurane may cause airway irritability |
| Opioids | |||
| Fentanyl | Induction: 1–5 μg kg−1 Maintenance: 0.2–2 μg kg−1 IVI: 0.5–5 μg kg−1 h−1 |
Does not promote BC | May cause cough |
| Alfentanil | Induction 10–20 μg kg−1 Maintenance: 5–10 μg kg−1 IVI: 30–120 μg kg−1 h−1 |
Does not promote BC | Respiratory depression |
| Sufentanil | Induction: 0.25-2mcg kg−1 Maintenance: 2.5–10 μg kg−1 IVI: 0.5–1.5 μg kg−1 h−1 |
Does not promote BC | Respiratory depression |
| Remifentanil∗ | Induction 0.1–1 μg kg−1 Maintenance: 0.2–1 μg kg−1 IVI: 0.1–1 μg kg−1 h−1 |
Does not promote BC | Skeletal muscle rigidity may occur Respiratory depression |
| Morphine | I.V.: 0.05–0.1 mg kg−1 | May cause BC through histamine release Respiratory depression |
|
| Muscle relaxants | |||
| Atracurium | 0.3–0.6 mg kg−1 | May cause BC through histamine release | |
| Vecuronium | 0.1 mg kg−1 | ||
| Rocuronium | 0.6–1 mg kg−1 | May have a higher risk of anaphylaxis | |
| Suxamethonium | I.V.: 1–2 mg kg−1 IM: 4–5 mg kg−1 |
||
| Other | |||
| Lignocaine | Airway topicalisation I.V. | May relieve BC | Topicalisation increases risk of postoperative airway adverse events11 Increase airway tone |
| Neostigmine | 50 μg kg−1 | May cause BC | |
| Glycopyrronium bromide | I.V.: 4–10 μg kg−1 (max 200 μg) | Reduces airway secretions | |
| Dexamethasone | I.V.: 0.3 mg kg−1 day−1 | Reduce airway inflammation | Should not be used if the child is already on regular steroids |
| Ondansetron | I.V.: 0.1–0.15 mg kg−1 (max 4mg) | ||
| Paracetamol | Check BNFC for dosing based on weight | ||
| Ibuprofen | Check BNFC dosing based on weight | Caution only if the child has known BC induced by NSAIDS. | |